Immunotherapy for Advanced Esophageal Squamous Cell Carcinoma—Renewed Enthusiasm and a Lingering Challenge
Mené sur 598 patients atteints d'un carcinome épidermoïde de l'oesophage de stade avancé ou métastatique, cet essai de phase II évalue l'intérêt, du point de vue de l'amélioration de la survie sans progression et de la survie globale, de l'ajout du camrélizumab à une chimiothérapie par paclitaxel et cisplatine
Esophageal cancer is the sixth leading cause of cancer-related mortality worldwide, with an estimated 544 076 deaths in 2020. It is also the seventh most incident cancer globally, with more than 50% of cases occurring in China alone. The diagnosis typically occurs in patients with locally advanced unresectable or metastatic disease, when palliative chemotherapy is the primary treatment option, and the 5-year survival rates can be as low as 5%. Esophageal cancer can be classified by histology as esophageal squamous cell carcinoma (ESCC) and esophageal adenocarcinoma (EAC). Esophageal adenocarcinoma is the most common among Western populations, occurs most often in the lower esophagus near the gastric junction, and is associated with obesity, gastric reflux, and a precursor state termed Barrett esophagus. Esophageal squamous cell carcinoma occurs predominantly in the upper and mid-esophagus and is associated with smoking and alcohol exposure, although ESCC risk factors among non-Western populations are less known. These histologies differ in risk factors, prognosis, and genetics. Despite ESCC’s high incidence, to our knowledge, robust clinical trials are scarce, and most of the evidence guiding its treatment comes from studies assessing ESCC and EAC combined. There has been little progress in treating esophageal cancer over the last 2 decades, with median overall survival (OS) for these patients remaining close to 11 months.